Thesis (Ph. D.)--University of Texas at Austin, 2005. / Supervisors: Kristin D. Neff and Stephanie S. Rude. Vita. Includes bibliographical references.

Providing care for a frail older adult who is suffering from dementia has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. The burden and stress is increased when the caregivers are themselves elderly. The present study investigated an 8-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), and compared it to a similarly structured, alternative behavioral intervention, Progressive Muscle Relaxation (PMR), to determine if MBSR was as effective or more effective than PMR at reducing subjective burden, symptoms of depression, perceived loneliness or perceived stress among middle-aged and older family caregivers of persons with dementia and other neurocognitive disorders. Twenty-eight participants were randomly assigned to either MBSR or PMR. Self-report and biological measures were collected on five occasions: At the beginning and end of intervention training, and at 8 weeks, 6 months and 1 year following the end of intervention training. In addition to a packet of self-report questionnaires and home-collected salivary cortisol, a laboratory controlled emotional stress test was designed to elicit an emotionally stressful response relevant to caregivers’ experience of caregiving, and facilitate the measurement of stress-related changes in systolic blood pressure and cortisol reactivity. At 1 year post-intervention, the PMR group showed a significantly greater reduction in perceived stress and disruptive patient behaviors. A reduction in emotional reactivity to patient problem behaviors approached significance (p = .08) at 1 year post-intervention for the PMR group. The MBSR group showed significantly greater reductions in self-reported symptoms of depression and perceived isolation from pre- to post-intervention, and those changes remained significant at 8 weeks post-intervention. However, by 1 year post-intervention, interaction effects were non-significant as both groups showed similar decreases in symptoms of depression and perceived isolation. Both groups showed similar decreases in diurnal cortisol, cortisol awakening response, and daily average cortisol (but not laboratory cortisol) from pre- to post-intervention and further decreases at 8 weeks post-intervention, and showed similar reductions in magnitude of change by 1 year post-intervention. This pattern was similar for both groups with systolic blood pressure, showing decreases from pre- to post-intervention, additional decreases at 8 weeks post-intervention, and returning towards baseline by 1 year post-intervention. Both groups also reported similar increases in levels of dispositional mindfulness and self-compassion and similar improvement in overall sleep quality that was sustained at 1 year post-intervention. No changes were seen for perceived burden or loneliness. Significant correlations with amount of daily practice of the instructed stress-reduction approaches were observed for several of the dependent measures from pre- to post-intervention and 8 weeks post-intervention. From pre-intervention to 1 year post-intervention, an overall pattern emerged, where both groups showed similar improvements from pre- to post-intervention, and additional improvements at 8 weeks post-intervention, but displayed a curvilinear reduction in improvements—with some exceptions—and a return towards baseline at 6 months and 1 year post-intervention. In general, reductions in the magnitude of changes observed by 1 year post-intervention remained below baseline levels. Results suggest that both MBSR and relaxation-based interventions may be differentially effective in reducing psychological and physiological indices of chronic stress among older caregivers of relatives with neurocognitive disorders. However, further research, employing wait-list control participants, will be necessary for unambiguous interpretation of the present results.

Psoriasis is a chronic skin condition that can impair physical, psychological and social functioning. A sub-population of people living with psoriasis believe that psychological stress exacerbates their physical symptoms. Stress may exacerbate psoriasis via a psychoneuroimmunological pathway. The cortisol awakening response can be used to indicate whether this pathway is functional or dysfunctional. People with psoriasis have an elevated risk of emotional distress (anxiety and depression) and an impaired quality of life. Mindfulness based cognitive therapy has been effective in reducing stress, emotional distress, quality of life impairment as well as improving physical health. The aim of this thesis is to examine the efficacy and acceptability of mindfulness-based intervention for people living with psoriasis and whether the cortisol awakening response mediates the relationship between perceived stress and physical severity of psoriasis. This thesis adopted a mixed-methods design. A pilot, randomised control trial examined the effects of mindfulness based cognitive therapy upon the physical severity, perceived stress, emotional distress, quality of life and cortisol awakening response of people living with psoriasis. These variables were entered into a correlation analysis to examine whether the cortisol awakening response was associated with any of the reported study outcomes (physical severity, perceived stress, emotional distress and quality of life). Completers of the mindfulness intervention were invited to a semi-structured interview to explore the characteristics of the participants who adhered to the intervention and their experiences of participating. The mindfulness intervention significantly improved physical (z=1.96, p=0.05) and quality of life (z=2.30, p=0.02) measurements without changing perceived stress (z=0.07, p=0.94), emotional distress (z=1.60, p=0.12) or cortisol awakening responses (z=-0.33, p=0.74). The overall cortisol awakening response was not associated with physical severity (r=-0.30, p=0.07) or perceived stress (r=-0.20, p=0.25) but was significantly correlated with emotional distress (r=-0.35, p=0.04). The intervention was perceived as an acceptable adjunct treatment option. Participants reported some process barriers that inhibited their learning of mindfulness skills. A profile emerged that described a sub-population of people with psoriasis. This sub-population may be more likely to accept and adhere to mindfulness based cognitive therapy.This thesis provides preliminary support to the concept that increasing mindfulness skill can reduce the physical severity and quality of life impairment in people with psoriasis. It recommends that a fully powered trial be conducted to examine the effectiveness of mindfulness in improving physical and overall functioning for people with psoriasis. This thesis suggests clinicians screen their patients and offer a psychological intervention best suited to their needs and characteristics.

Mindfulness-based interventions use meditation and other learning exercises to help individuals become more aware of their current physiological and emotional experiences. Benefits of practicing mindfulness include an increase in positive psychological outcomes (e.g., psychological well-being, emotion regulation) and a decrease in negative psychological outcomes (e.g., anxiety, depression). The vast majority of studies focus on younger rather than older adults—setting the stage for the current study, which involved delivering a five-session mindfulness-based intervention to older adults (i.e., 60 and older). The smaller literature focused on older adults is promising but generally lacks methodological rigor (e.g., lack of no-treatment control groups). The current study added to the existing literature by conducting a longitudinal quasi-experimental delayed treatment trial in a sample of older adults. First, it was hypothesized that there would be an intervention effect on several variables. Specifically, it was hypothesized that participants would experience decreases in depression, anxiety, and stress, as well as increases in the five facets of mindfulness, psychological well-being, and emotional regulation. Second, it was hypothesized that the mindfulness-based intervention would be feasible and acceptable, as indicated by low levels of intervention noncompliance and participant attrition as well as high scores in satisfaction and practice log completion rates. Participants were 19 older adults from a local retirement community. Participants were assigned to either an immediate treatment (n = 11) or delayed treatment (n = 8) group. All participants were assessed at the universal baseline, week 5 (i.e. intervention completion of immediate treatment group), week 10 (i.e. intervention completion of delayed treatment group), and at week 15. The 5-week mindfulness-based intervention included psychoeducation (e.g., mindfulness, stress, aging, values), discussion of all concepts, and mindfulness practice. A series of two (group) by four (time of assessment) analysis of covariance models were estimated to evaluate primary outcomes. Results indicated that there was no significant treatment effect on primary outcomes. However, the mindfulness-based intervention was feasible and acceptable. Gaining additional knowledge of how mindfulness-based interventions influence coping strategies in older adults will allow clinicians and researchers to influence interventions for older adults and facilitate older adults receiving adequate psychological treatment while managing common stressors associated with aging.

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Stress is a global health issue and effective stress management techniques are much needed. Mindfulness meditation in the form of mindfulness-based interventions have been shown to be effective interventions for self-reported stress reduction. However, the effects of mindfulness meditation on the objective physiological markers of stress are less clear. Heart rate variability, the variation in time between each consecutive heartbeat has been shown to be such an objective physiological marker of stress. The aim of this systematic review was to investigate how mindfulness-based interventions affect heart rate variability to better understand the utility of mindfulness meditation as a stress management technique. A literature search was conducted on March 8th, 2022, with the databases Web of Science, Scopus, and MEDLINE EBSCO to identify randomized controlled trials that examined the effects of mindfulness-based interventions on heart rate variability. A total of 10 studies met the inclusion criteria with a total of 970 participants. The results from the systematic review were mixed and indicate inconsistencies across the literature. Thus, there are uncertainties on how mindfulness-based interventions affect heart rate variability. Although the systematic review was limited by a small sample of studies, it highlights that further research on how mindfulness-based interventions affect heart rate variability is needed to better understand the utility of mindfulness meditation as a stress management technique.

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More and more people are affected by stress in their work lives, and it is in society’s interest to decrease the levels of stress [15]. There are several approaches that can be used to reduce stress, such as bodily exercises, digital aids, psychological treatment programs, or relaxation exercises. A new psychological program called Mindfulness-Based Cognitive Therapy (MBCT), originally used to prevent relapses in depression, can also help to treat stress. However, not much research has been conducted on the effects of MBCT to treat stress, and even less on how to design for web solutions for this treatment. The aim of this study is to investigate and explore how web solutions for mindfulness-based cognitive therapy used to treat stress can be designed, with the research question Based on an informed understanding of Mindfulness-Based Cognitive Therapy, how might we, from a design perspective, design a novel web application for it? To investigate this, a research through design approach was used, and the method “future workshop” for the evaluation of the design prototype. The results of this study suggest that when designing websites for MBCT treatments, the most important features to include are visual representations of the patient’s progress and regulated home assignments. The visual representations should show the correlation between stressors and mood, and the regulation would provide assurance to the therapist that the patient does the home assignments. However, more research should be done to further explore the design space in web solutions for mindfulness-based cognitive therapy. / Fler och fler människor påverkas av stress på sina arbeten och det ligger i samhällets intresse att minska stressnivåerna [15]. Det finns flera tillvägagångssätt att minska stress, som exempelvis att göra kroppsliga övningar, använda digitala hjälpmedel, psykologiska behandlingsprogram eller avslappningsövningar. Ett nytt psykologiskt program kallat mindfulnessbaserad (medveten närvaro) kognitiv terapi (MBCT), ursprungligen använt för att förhindra återfall av depression, användas också för att behandla stress. Däremot har det inte gjorts mycket forskning om MBCT:s effekter för att behandla stress, och än mindre om hur man kan designa webblösningar för denna behandling. Målet för denna studie är att undersöka och utforska hur man kan designa webblösningar för mindfulnessbaserad kognitiv terapi som används för att behandla stress med frågeställningen Baserat på befintlig information om mindfulnessbaserad kognitiv terapi, hur kan man, från ett designperspektiv, designa en ny webbapplikation för den? För att undersöka det användes det iterativa tillvägagångssättet ”research through design” och metoden ”future workshop” för att utvärdera designprototypen. Denna studies resultat föreslår att de viktigaste funktionerna att inkludera i designandet av hemsidor för MCBCT-behandlingar är visuella representationer av patientens utveckling, samt reglerade hemuppgifter. De visuella representationerna borde visa korrelationen mellan stressorer och humör, och regleringen skulle garantera terapeuten att patienten gör hemuppgifterna. Däremot bör mer forskning göras för att ytterligare utforska designområdet inom webbaserade lösningar för mindfulnessbaserad kognitiv terapi.